PM&R Vol. 6, Iss. 8S2, 2014 S101

six months. Interventions: 12 sessions of controlled supervised exerciseprotocol within a cardiac rehabilitation program and educational program.Main outcomes: The main outcome in the study were the PRO-BNPlevel at 8 weeks the secondary outcomes were VO2 changes in the exercisetest functional capacity and quality of life. Evidence level: 1.Results: 23 patients were included in the intervention group and 26 inthe control group. Five patients died, six did not complete the evaluation,and one patient did not perform the exercise test. 17 patients wereanalyzed in the intervention group and 20 in the control group. Aftercompleting the supervised exercise program PRO-BNP and VO2 levels didnot change in a statistically significant way between the groups. Thequality of life evaluated with the medical outcome study (SF-36) improvedin the intervention group on the next dimensions: change in health statusperception (p 0007) emotional performance (p 0011) physical perfor-mance (p 0006) physical function (0024) mental health (p 0009) andoverall health (p 001). Conclusion: A supervised exercise program inpatients with heart failure does not modify the PRO-BNP leves or the VO2

at 8 weeks however it does improve health related quality of life.

No. 18 Benefits of Cardiac Rehabilitation in Heart FailurePatients Receiving Continuous-Flow Left Ventricular AssistDevice in Early Postoperative Period.Chen-Yu Hung; Ssu-Yuan Chen; Shoei-Shan Wang; Ching Lan.

Objective: To investigate the effect of cardiac rehabilitation (CR) on theexercise capacity, physiological variables of ventilatory efficiency duringsubmaximal exercise and health-related quality of life (HRQOL) amongheart failure patients receiving the second-generation continuous-flowleft ventricular assist device (LVAD) in early postoperative period.Design: Case series study. Setting: CR center in a tertiary hospital.Participants: Clinically stable heart failure patients who receivedcontinuous-flow LVAD implantation during 2011-2013 at a universityhospital were recruited for this study. Interventions: Outpatient CR.Main Outcome Measures: We performed cardiopulmonary exercisetesting (CPET) at baseline and after CR. The outcome variables includedpeak oxygen uptake (peak VO2), peak workload ventilation-to-carbondioxide output (VE/VCO2) slope, oxygen uptake efficacy slope (OUES)and oxygen uptake efficiency plateau (OUEP). The HRQOL was evaluatedby the medical outcomes trust 36-item health survey (SF-36). Level ofEvidence: Level 3 evidence. Results: Four patients (age 44.5 � 6.2years; 3 men 1 woman) participated in a 2-month outpatient CR programat 35 � 12 days after LVAD implantation. After CR obvious increase inpeak VO2 (13.1 � 2.0 to 16.3 � 1.1 ml/kg/min), peak workload (54 � 14to 73 � 16 watt), OUES (1228 � 229 to 1590 � 318 ml/min/log (l/min)),OUEP (31.0 � 4.6 to 33.5 � 1.9 ml/l) and decreased VE/VCO2 slope (35.8� 2.7 to 31.1 � 4.3) were observed. Increase of SF-36 HRQOL scores wasalso observed in physical functioning (58.8 � 8.5 to 77.5 � 22.2) and rolephysical (18.8 � 37.5 to 50.0 � 57.7). Conclusions: CR is safe andbeneficial for exercise capacity ventilatory efficiency and HRQOL in heartfailure patients using continuous-flow LVAD in early postoperative period.

No. 19 Effects of Music and Exercise Combination onCardiac Autonomic Nervous System.Tiantian Jia; Yoshiko Sakata; Misa Miura; Masahiro Kohzuki.

Disclosure: None. Objective: Exercise increases sympathetic nervousactivity. The exercise-induced sympathetic activation could trigger fatalevents such as ventricular arrhythmia and sudden cardiac death. Previousstudies reported that music increased parasympathetic nervous activity.Music may therefore attenuate the exercise-increased sympathetic nervousactivity. To establish this hypothesis we investigated effects of musicand exercise combination on cardiac autonomic nervous system.Design: Cross-over study. Setting: Listening to music and exercise.

Participants: Thirty healthy adults. Interventions: Subjects partici-pated in four sessions on four separate days: 1) a music session 2) a bicy-cling session 3) a music and bicycling session and 4) a sedentary session.Subjects were asked to listen to their favorite music in the music session, toexercise on a cycle ergometer in the bicycling session, and to exercise whilelistening to the music in the music and bicycling session. Each sessionproceeded for fifteen minutes. Main Outcome Measures: Heart rate(HR), systolic blood pressure (SBP), diastolic blood pressure (DBP), andcardiac autonomic nervous activity. Level of Evidence: level 1 (likelyreliable). Results: Music significantly decreased HR, SBP, and DBPaccompanied with the significant increase of high frequency power (HF)which was obtained an index of parasympathetic nervous activity by powerspectrum analysis of heart rate fluctuations. Exercise significantly increasedHR and the ratio of low frequency power to HF (L/H) which indicated thesympathetic nervous activity whereas it significantly decreased HF. Exer-cise and music combination did not significantly increased L/H and notdecreased HF. Conclusions: This study demonstrated that musicincreased the parasympathetic nervous activity and tended to attenuate theexercise-increased sympathetic nervous activity in healthy adults. Musicmay be an effective approach for preventing fatal cardiac events duringexercise.

No. 21 Accuracy of Heart Rate Measurement UsingSmartphone and Prototype Application During TreadmillExercise.Se-Eung Noh, M.D; Jin-Seok Lee Deng; Hyun-Jun Kim;Min-Cheol Joo.

Objective: To evaluate the accuracy of heart rate measurement by usingsmart phone (i-Phone 4s Apple, USA) and application (Atrial FibrillationDiagnostic Prototype Application, Department of Biomedical Engineering,Wonkwang University School of Medicine Iksan, Republic of Korea) duringtreadmill exercise. This study is a preliminary study for development ofcardiac rehabilitation exercise smartphone applications. Setting: Heart ratecheck during treadmill exercise. Participants: 29 healthy adult volun-teers. Intervention: To measure heart rate, volunteers grabbed smartphonein hand and index finger placed on the camera of an iPhone 4s for 1 minute.The iPhone 4s can record a pulsatile photo-plethysmogram signal fromfingertip using the built in camera lens and the prototype application cananalyze pulse rate fluctuation. Bruce protocol was used for treadmill exer-cise. They were measured heart rate at resting stage, during exercise at BruceStage II, Bruce Stage III, and recovery stage by the prototype applicationusing iPhone 4s and EKG telemetry (Q-Tel Cardiac Science Waukesha,Wisconsin, USA). And we compared both methods. Main OutcomeMeasures: The error rates percent ¼{[｜Application HR e EKG HeartRate｜/ EKG Heart Rate ] x 100 } Result: The average heart rates ofapplication and EKG telemetry were 75.0�12.8 and 77.2�12.0,113.1�16.6 and 114.7�17.1, 156.8�15.3 and 162.1�13.3, 99.8�11.9and 102.4�11.41 in resting stage, Bruce Stage II, Bruce Stage III, andrecovery stage. The error rates were 3.8%�2.6%, 3.3%�2.7%, 4.2%�4.0%,and 3.8%�2.9% in resting stage, Bruce Stage II, Bruce Stage III, andrecovery stage. Average error rates were increased slightly in exercise stagesthan resting stage. Conclusion: The results showed low average error ratepercent, so we think it possible to develop a home cardiac rehabilitationexercise application. In the future using the proven diagnostic function ofthis application we think it can be possible to develop a real-time cardiacmonitoring application.

No. 22 The Paradox of Obesity and Its Relationship toCardiorespiratory Fitness in Patients With Heart Failure.Robinson Ramírez-Vélez; Lisbeth Triviño-Quintero;Juan Carlos Ávila.

Disclosure: None. Objective: The aim of this study was to evaluatethe relationship between the “obesity paradox” with cardiorespiratory